Register Your Dog

Location

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PET INFORMATION

Dog's Name *

Colour *

Breed *

You dog's age (if not sure, best guess!)

Your dog's gender *

Do you have other pets?

How long has your dog lived with you?

Where did you get your dog?

Are they being dewormed regularly?

What do you feed your dog?

Who was your previous Veterinarian? (So that we may access their medical records)

Full Name *

Email *

Address *

City

Province *

Postal Code *

Home Phone

Work Phone

Cell Phone *

If you would like your Spouse’s name added to the file, please provide it here:

If you were referred by a friend, who can we thank?
(Refer a friend and receive 50% off your next office exam)

Can we post a picture of your dog on our Facebook Page?

Yes
No

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY * *